- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,007.23 / $5,838.04 / $14,867.45
| Facility | | $2,007.23 | $5,838.04 | $14,867.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,861.00 / $28,147.00 / $30,324.00
| Facility | | $21,861.00 | $28,147.00 | $30,324.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $2,002.07
| Facility | | $640.00 | $640.00 | $2,002.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.46 / $2,145.87 / $2,516.09
| Professional | | $1,676.46 | $2,145.87 | $2,516.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.05 / $2,359.94 / $3,332.34
| Facility | | $1,824.05 | $2,359.94 | $3,332.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.88 / $2,268.78 / $7,420.00
| Facility | | $1,725.88 | $2,268.78 | $7,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,621.00 / $20,974.00 / $40,876.00
| Facility | | $7,621.00 | $20,974.00 | $40,876.00 |